The many shades of international cooperation in global health

Newsletter Edition #107 [The Weekly Primer]

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Days pass by quicker towards the end of the year. Both at WTO and WHO, countries are mustering up everything they have to reach consensus on how the world should be better prepared for health emergencies in the future.

This is even as existing inequities are exacerbating at a frightening pace. The WHO reported last week, “every day, there are six times more boosters administered globally than primary doses in low-income countries.”

It is hard to understand if international cooperation is failing so spectacularly now, how does one repose faith that it will be different in the future even if straitjacketed by new rules.

Drowning in the details as we are on how these negotiations are taking shape, we still hope to see the bigger picture and understand what all this really means. Write to us on how to make sense of these impending changes in global health.

Check out our exclusive from last week: The Emerging Path to the TRIPS Waiver.

Today we are announcing a two-week Black Friday sale. If you have been thinking of subscribing to us, but have not yet done so, here is your chance! We are offering a 30% discount to all new subscribers who sign up before 28 November. If you are an institution interested in a group subscription, get in touch with me.

Thank you for reading.

Until Friday!



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This week, WHO member states adopted a report from the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies, that will be discussed at the special session of the World Health Assembly later this month.

The report proposes establishing an inter-governmental negotiating body in charge of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response. It also seeks the way toward a “clear, efficient, effective, Member State led, transparent and inclusive process” to identify and develop the substantive elements and a zero draft of a new instrument, including modalities and timelines. In addition, it requests for support in implementing the recommendations that fall under the technical work of WHO and to further develop proposals to strengthen the IHR (2005), including potential targeted IHR (2005) amendments, and elements that may most effectively be addressed in other venues.

Some experts note that seeking to establish a parallel inter-governmental negotiating body (INB) in addition to proceedings at the WGPR, will cause fragmentation and make these negotiations difficult for smaller delegations. While the INB could discuss a new legal instrument, the WGPR is expected to address other elements including strengthening of the IHRs and implementing recommendations suggested by the various panels.

The report was adopted at the Fifth Meeting Of The Working Group On Strengthening WHO Preparedness And Response To Health Emergencies.

Member states were informed that the Working Group will convene in early January to draft a report for the WHO Executive Board 150th session in January 2022. Co-Chair of the Working Group Colin Mciff of USA, told member states that a survey will be conducted in the meantime, according to sources present at the meeting. Countries including the US sought more details on the survey, and China asked for transparency in the discussions. According to a source, the EU, the chief proponent for a pandemic treaty, thanked civil society organizations in reaching consensus on the report.

EXCLUSIVE: It is understood that Chile and Australia have circulated a proposal for a draft decision for the Assembly later this month. A copy of the this proposal has been seen by Geneva Health Files.

The proposal suggests the setting up of an INB, to draft and negotiate a new instrument. It suggests two meetings in February 2022 and July 2022, and proposes that an outcome be submitted to the Seventy-seventh World Health Assembly.

Specifically it seems to suggest “a legally binding instrument on pandemic prevention, preparedness and response under Article 19 of the WHO Constitution”. Some of the text is already bracketed. (Note that during the WGPR consultations, a number of countries pushed back against the Article 19 route citing no consensus on the matter)

There are several informal consultations planned in the coming days to discuss this proposal leading up to the World Health Assembly Special Session.

(See our earlier story: Round One to the EU & Friends: "Treaty" Option Gains Support)

Secretary Antony J. Blinken Remarks At A Virtual COVID-19 Ministerial

A very clear securitization agenda set by the U.S. See excerpts of this speech here:

“This is the first time that we foreign ministers have gathered for the sole purpose of discussing how to end the COVID-19 pandemic since this began nearly two years ago.

This pandemic has taught us that preventing and responding to global health emergencies cannot be the responsibility only of health ministers or global health experts, because a pandemic isn’t just a health crisis. It’s also a security crisis, an economic crisis, a humanitarian crisis. That’s why we need foreign ministers to step up and lead as well, and I hope this is the first of many regular discussions among us about global health security.…..

…..We’ll also talk today about the future because we foreign ministers have a critical role to play in laying the foundation for stronger health security beyond this pandemic. We’re uniquely positioned to address gaps in global governance so our countries can respond to health crises with the same urgency and immediacy that we bring to national security crises, sharpen regional coordination to improve preparedness and response, and strengthen key institutions like the WHO to modernize it and make sure it has the resources it needs to take on future pandemics more effectively.”

He also announced:

“A new public-private partnership called the Global COVID Corps will help. Through this initiative, leading private sector companies will work pro bono to share their expertise and capabilities to support vaccination campaigns, taking on issues like managing supply chains and helping optimize vaccine sites to deliver shots as quickly and safely as possible. The private sector has unique skills and resources to bring to bear in this fight….”

(Also see: The US seeks to water down WTO trade and health declaration: Politico: “In particular, the U.S. version slashes the section limiting the permissible duration of export restrictions, cuts a transparency clause on the need for WTO monitoring and removes all mentions of the humanitarian COVAX program”)


TRIPS Council Meeting: 15 November

At a formal TRIPS Council meeting at WTO this week, members agreed to continue consultations on the IP response to the pandemic ahead of the 12th Ministerial Conference (MC12)

While there is no consensus yet on the TRIPS Waiver, discussions will remain "open" on the agenda of the TRIPS Council. Sources say discussions on the waiver could continue up until MC12.

At another meeting on 18 November, members will adopt a status report that will be submitted to the WTO General Council on 22-23 November.

South Africa believes there is "enough goodwill and pragmatism" to reach a meaningful outcome. Given the continuing divergences, the EU asked members to "move from their initial positions". Discussions will continue bilaterally.

Dagfinn Sørli, TRIPS Council chair is reported to have said that "The role of IP in the context of the pandemic has become the centre of attention in the run-up to the ministerial conference,” underscoring the need to arrive at an outcome in time for the ministerial.

See our story from last week The Emerging Path to the TRIPS Waiver.

AstraZeneca to take profits from Covid vaccine sales: Financial Times

“AstraZeneca has signed its first for-profit deals for its Covid-19 vaccine, moving away from the completely non-profit model that it used during the pandemic. The Anglo-Swedish drugmaker is now expecting the vaccine will move to “modest profitability” as new orders are received. The shot, developed with the University of Oxford, will remain non-profit for developing countries. AstraZeneca committed to selling the vaccine “at cost” for the duration of the pandemic, as part of its agreement with Oxford.

Pascal Soriot, AstraZeneca’s chief executive, said the company had consulted with experts and concluded Covid-19 was entering an “endemic phase” and that it would be the right time to switch contracts for many countries in the next year. He added that in the fourth quarter, the majority of doses would still be under existing non-profit contracts.

….The company booked $1bn in revenues from the vaccine in the third quarter, far less than rivals that charge more. Pfizer generated $13bn in sales from its vaccine and Moderna reported revenue of $5bn, the vast majority from its Covid-19 vaccine.

Financial Times

International organizations, vaccine manufacturers take stock of COVID-19 vaccine roll out, share views for 2022: WTO


My colleague Rithika has put this together for you:





WHO: Informal consultations on the draft decision for the World Health Assembly Special Session: 16, 18 November

WTO: TRIPS Council Meeting: 18 November


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